Diagnostic yield of high-resolution manometry with a solid test meal for clinically relevant, symptomatic oesophageal motility disorders: serial diagnostic study
Diagnostic yield of high-resolution manometry with a solid test meal for clinically relevant, symptomatic oesophageal motility disorders: serial diagnostic study
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DOI：
10.1016/s2468-1253(17)30148-6
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发表时间：
2017-09-01
影响因子：
35.7
通讯作者：
Fox, Mark
中科院分区：
文献类型：
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作者：
Ang, Daphne;Misselwitz, Benjamin;Fox, Mark
高分辨率测压仪（HRM）诊断食管运动障碍是基于10次单吞水（SWS）；然而，这种方法可能不能代表正常食物摄入时的食道功能。我们测试了将标准化固体测试餐（STM）纳入HRM研究是否会增加对主要运动障碍的测试敏感性。此外，我们评估了STM期间患者症状的频率和原因。方法在发展研究中招募来自诺丁汉大学医院（Nottingham， UK）的食管症状调查患者，在验证研究中招募来自苏黎世大学医院（Zurich, Switzerland）的患者。人力资源管理是在直立，坐着的位置与固态组件。在HRM期间，患者摄入10个SWS，然后是一个标准化的200g STM。食管运动障碍的诊断基于芝加哥分类，分别对SWS （CCv3）和STM （CC-S）进行了验证。这些研究已在ClinicalTrials注册。NCT02407938和NCT02397616。发展队列包括750例患者，其中360例（48%）有吞咽困难，390例（52%）有反流或其他症状。验证队列包括221例患者，其中98例（44%）有吞咽困难，123例（56%）有反流症状。在开发组（321例[43%]vs 163例[22%]，p< 0.0001）和验证组（73例[33%]vs 49例[22%]，p= 0.014）中，使用STM诊断为严重运动障碍的患者多于使用SWS的患者。这种增加在吞咽困难患者中最为明显（360例STM患者中有241例[67%]vs 125例[35%]，p< 0.0001），但在有反流症状的患者中也存在（329例患者中有64例[19%]vs开发组中有32例[10%]，p= 0.00060）。750例患者中有9例（1%）在SWS期间出现症状再现，461例（61%）在STM期间出现症状再现（p< 0.0001）。321例重度运动障碍患者中有265例（83%）和152例轻度运动障碍患者中有107例（70%）在STM期间报告了症状（p= 0.0038），而277例运动正常的CC-S患者中有89例（32%）报告了症状（p< 0.0001）。与SWS相比，使用STM可提高HRM对主要运动障碍的诊断敏感性，尤其是对吞咽困难患者。在STM期间进行的观察可以确定运动障碍是食管症状的原因。
Background The use of high-resolution manometry (HRM) to diagnose oesophageal motility disorders is based on ten single water swallows (SWS); however, this approach might not be representative of oesophageal function during the ingestion of normal food. We tested whether inclusion of a standardised solid test meal (STM) to HRM studies increases test sensitivity for major motility disorders. Additionally, we assessed the frequency and cause of patient symptoms during STM.Methods Consecutive patients who were referred for investigation of oesophageal symptoms were recruited at Nottingham University Hospitals (Nottingham, UK) in the development study and at University Hospital Zurich (Zurich, Switzerland) in the validation study. HRM was done in the upright, seated position with a solid-state assembly. During HRM, patients ingested ten SWS, followed by a standardised 200 g STM. Diagnosis of oesophageal motility disorders was based on the Chicago Classification validated for SWS (CCv3) and with STM (CC-S), respectively. These studies are registered with ClinicalTrials. gov, numbers NCT02407938 and NCT02397616.Findings The development cohort included 750 patients of whom 360 (48%) had dysphagia and 390 (52%) had reflux or other symptoms. The validation cohort consisted of 221 patients, including 98 (44%) with dysphagia and 123 (56%) with reflux symptoms. More patients were diagnosed with a major motility disorder by use of an STM than with SWS in the development set (321 [43%] patients diagnosed via STM vs 163 [22%] via SWS; p< 0.0001) and validation set (73 [33%] vs 49 [22%]; p= 0.014). The increase was most evident in patients with dysphagia (241 [67%] of 360 patients on STM vs 125 [35%] patients on SWS in the development set, p< 0.0001), but was also present in those referred with reflux symptoms (64 [19%] of 329 patients vs 32 [10%] patients in the development set, p= 0.00060). Reproduction of symptoms was reported by nine (1%) of 750 patients during SWS and 461 (61%) during STM (p< 0.0001). 265 (83%) of 321 patients with major motility disorders and 107 (70%) of 152 patients with minor motility disorders reported symptoms during the STM (p= 0.0038), compared with 89 (32%) of 277 patients with normal motility as defined with CC-S (p< 0.0001).Interpretation The diagnostic sensitivity of HRM for major motility disorders is increased with use of the STM compared with SWS, especially in patients with dysphagia. Observations made during STM can establish motility disorders as the cause of oesophageal symptoms.